1Interview & history
Start with the person, then their health, function and equipment. This follows the person-centred, individualised assessment the WHO Wheelchair provision guidelines (2023) recommend.
About the person
Interests & activities
Communication
Diagnoses, medical & surgical history
Relevant conditions
GMFCS level (if applicable)
Surgical history
Reasons for admission
Tone & movement
Where
Tone management
Body systems
Respiration
Digestion & feeding
Route
Circulation
Continence
Sleep
Sleep position(s)
Sleep issues
Skin integrity & pressure injury risk
The risk domains below follow the International Pressure Injury/Ulcer Guideline, 4th edition (NPIAP / EPUAP / PPPIA, 2025). The guideline says to use a structured approach, include a full skin assessment and use clinical judgement. Don't rely on a tool's total score alone: use its subscales to target prevention.
Perfusion, circulation & oxygenation
Weight shifting
Independent, consistent & effective?
Current equipment & technology
Tick what's in use. Record make/model, size, age, fit and condition.
| Item | Type | Details, fit & condition | Hrs / day |
|---|
Mobility & independence
Manual wheelchair
Propulsion method
| Activities of daily living | Independent | Set-up | Assisted | Dependent | Notes |
|---|
Outcome measures
2Assessment in sitting
A snapshot of this moment. Complete this section with the person in their current seating system, as they are. Don't reposition them or change anything: leave lateral supports, arm supports, pelvic positioning belt etc. as found.
Current seating system Seat-to-back angle ° Measure on the current seating system. Used later to work out the hip flexion the seating requires (hip flexion = 180° − seat-to-back angle, e.g. 100° → 80°).
ALife Box · relationship between the ribs and the pelvis
Landmarks: R and L ASIS, and the inferior angle of the ribs (lowest point of the rib cage) on each side. Picture the box joining these four points.
Tick all that apply (e.g. closed and a parallelogram).
If parallelogram: ribs shifted towards relative to the ASISs
Draw the shape you see (inferior angle of ribs above, ASISs below; viewed from the front)
BPelvic position
Transverse plane
If measured Transverse pelvic angle °
Landmarks: R and L ASIS, viewed from above; reference = line across the seat (side to side).
Sagittal plane
If measured Sagittal pelvic angle ° (+ posterior / − anterior tilt)
Landmarks: ASIS and PSIS (line perpendicular to the ASIS–PSIS line); reference = vertical, viewed from the side.
CSitting footprint
A rough check of loading areas for symmetry, gaps and peak pressure. Score each area 0–3, then use Notes for finer grading (e.g. 2+, 2−, 3+++) and to say exactly where (e.g. lateral aspect of foot only, mid-femur only, inferior angle of scapula).
0 = no contact1 = contact, no load2 = optimal load3 = excessive load
Inferior support (seat & feet)
| Area | R | L | Notes (grading +/−, exact area) |
|---|
Posterior support (back)
| Area | R | L | Notes (grading +/−, exact area) |
|---|
| Midline | Score | Notes (grading +/−, exact area) |
|---|
Loading map
Fills in automatically as you score each area above. Each area is coloured by its loading score, so you can see asymmetries, gaps and peak pressure at a glance. On paper: write the score in each area (or shade it) to build the same picture. An asterisk (*) means there's a note for that area.
✓Sitting summary
!Screening result · is a hands-on assessment in supine needed?
If the person has an open, symmetrical Life Box, a neutral pelvis in all three planes, and optimal loading posteriorly and inferiorly with no asymmetry, gaps or peak pressure areas, a full hands-on assessment in supine is not indicated. Any asymmetry or flattening of the Life Box, any pelvic deviation from neutral in any plane, or any asymmetry, gap or excessive pressure means a supine assessment is necessary, and no changes to the seating system should be made or suggested until it has been done.
3Assessment in supine
On a firm plinth or mat. Split into Pelvis-up (finding the optimal Life Box) and Pelvis-down (what the hips, knees and ankles allow while that Life Box is kept).
APelvis-up · mobility & position
Goal: find this person's optimal Life Box, their resting position in supine. In each plane, assess mobility first, then record the optimal / resting position. Each finding is recorded pelvis first, then trunk.
Optimal = resting. Move slowly and stop just before you feel any tension or stretch, or see any movement. That point is the optimal position to record. If the Life Box (or a joint) can be pushed further but only against tension or stretch, that is no longer resting.
Measuring in supine: take the long axis of the plinth as the vertical reference (Y) and a line across the plinth as horizontal (Z).
Transverse plane
⚠ Make sure the legs can move freely, so the hips aren't driving the pelvic rotation.
Optimal / resting position Transverse pelvic angle °
Landmarks: R and L ASIS, viewed from above (from the feet in supine); reference = line across the plinth.
Sagittal plane
With a large anterior pelvic tilt: flex the legs as much as needed to bring the pelvis as close to neutral as possible (if there is lumbar mobility), then assess hip extension in pelvis-down (step 2).
Optimal / resting position Sagittal pelvic angle (pelvic tilt) °
Landmarks: Sagittal pelvic angle: ASIS and PSIS (line perpendicular to the ASIS–PSIS line), viewed from the side. Posterior tilt = +, anterior tilt = −. In supine, measure relative to the trunk lying on the plinth.
Thoracic spine (mid–upper): extension
If they can extend through the thoracic spine, support that extension in sitting. If they can't, accommodating the kyphosis is a key feature of the back support.
Shoulders: protraction
Optimal Life Box
Landmarks: R and L ASIS, and the inferior angle of the ribs on each side.
Tick all that apply.
If parallelogram: ribs shifted towards relative to the ASISs
Draw the optimal shape
The pelvis-up findings show the position the pelvis will need to be in when sitting.
BPelvis-down
Keep the optimal Life Box (from pelvis-up) for the rest of the pelvis-down assessment. For every movement (hips, hamstrings / knees, ankles, abduction / adduction, rotation), stop just before any tension or stretch is felt, or any movement of the pelvis or Life Box is seen. That point is the resting position to record.
1Pelvic tilt held during pelvis-down
Sagittal pelvic angle held °
Leave blank to use the pelvis-up value.
2Hip flexion / extension · one measurement
Start with the hip in the position where the optimal Life Box (from pelvis-up) is kept, with the knee relaxed. Slowly flex / extend the hip. Stop just before any of these happen, and measure there:
- any tension or stretch is felt
- the pelvis moves: posterior tilt when flexing, anterior tilt when extending, or an obliquity (the pelvis hitches up on the side being tested)
- the Life Box changes or shifts
- pain or tone appears
Limited flexion and limited extension are the same measurement seen from either end, so a hip will only ever be limited one way relative to the seating. Record the resting position below, and the range if useful.
Measure whichever you use. The form works out the others.
Hip flexion and the seating angles add up to 180°
• Thigh-to-trunk = 180° − hip flexion measured against the trunk
• Thigh-to-pelvis = 180° − hip flexion measured against the pelvis (true hip flexion)
• Neutral pelvis (sagittal pelvic angle 0°): thigh-to-trunk = thigh-to-pelvis = 180° − hip flexion
• With a pelvic tilt: thigh-to-pelvis = thigh-to-trunk + pelvic tilt (posterior +, anterior −)
So if only hip flexion was measured, both seating angles can still be worked out from it and the pelvic tilt.
Example: hip flexion 85° (against trunk), posterior tilt +15° → thigh-to-trunk 95°, thigh-to-pelvis 110°, true hip flexion 70°.
R hip: what happened just past the resting position?
L hip: what happened just past the resting position?
Hip flexion the seating requires ° Usually 90°. More if sitting in a bucket / dump, less with an open seat-to-back angle. Used to decide whether hip flexion is limited relative to the seating.
3Knee extension / flexion
Rectus femoris (e.g. with limited hip extension / anterior pelvic tilt): flex the knee and stop just before tension or stretch, or the pelvis is pulled into an anterior tilt. This person may need more knee extension, with the foot in front of the foot support.
Joint (less common, but possible): e.g. a knee contracture, where there is no additional muscle tension and the pelvis doesn't move, but the knee simply has no further movement. Record the angle where the movement stops.
Keep the hip flexed to the angle found above. Extend the knee and stop just before any hamstring tension or stretch is felt, or the pelvis moves (posterior tilt, obliquity or a change in the Life Box).
Knee flexion = 180° − thigh-to-lower-leg angle
R knee: what happened just past the resting position?
L knee: what happened just past the resting position?
Thigh-to-lower-leg angle the seating requires ° Depends on the foot support / hanger position (e.g. about 90° with feet under the knees, more with front rigging). Used to decide whether knee extension is limited relative to the seating.
4Ankle dorsiflexion / plantarflexion
Keep the hip and knee at the angles found above. Dorsiflex the ankle slowly and stop just before any tension is felt in the Achilles tendon / gastrocnemius, the knee or hip angle changes, the pelvis moves (e.g. a posterior pelvic tilt, or pelvic rotation to bring the origin and insertion of gastrocnemius closer together), the Life Box changes, or pain or tone appears.
Ankle: lower-leg-to-foot < 90° = dorsiflexion, > 90° = plantarflexion
R ankle: what happened just past the resting position?
L ankle: what happened just past the resting position?
Hip & knee diagram · steps 2, 3 and 4 together
5Hip abduction / adduction
Keep the leg at the hip and knee flexion angles found above. Record the resting position: stop just before any tension or stretch, or any pelvic rotation.
R hip: what happened just past the resting position?
L hip: what happened just past the resting position?
Landmarks: thigh line from the hip joint centre to the centre of the patella, compared with a line perpendicular to the ASIS–ASIS line (neutral). Watch the ASISs for pelvic rotation.
6Hip internal / external rotation
Same leg position. Stop just before any tension or stretch, or any pelvic obliquity.
R hip: what happened just past the resting position?
L hip: what happened just past the resting position?
Landmarks: with hip and knee flexed, lower leg line from the tibial tuberosity to the midpoint of the ankle, compared with vertical (neutral). Watch the ASISs for pelvic obliquity.
CMeasurements & observations in supine
Lower limb circumference
Checks for asymmetry in thigh mass that could contribute to a pelvic obliquity. Less mass under one side lets that side sit lower. The solution is to raise the seating surface under the low side to make up for the missing mass, so the pelvis sits level.
Chest wall · optional, e.g. Goldsmith Indices of Body Symmetry (trained measurers)
Landmarks: crook lying with the pelvis and shoulders level; measure at the level of the xiphoid process: xiphoid process to the lateral border of the chest on each side, and chest depth at the xiphoid.
| Width (R + L) | Depth : width ratio | Right : left ratio |
|---|
| — | — | — |
R : L ratio = 1 means symmetrical; below 1 = anticlockwise, above 1 = clockwise (Goldsmith convention).
Linear body measures · optional (Waugh & Crane, Fig. 4.2; measure as defined there)
| Measure | R / single (cm) | L (cm) | Measure | R / single (cm) | L (cm) |
|---|